Letter from Myanmar

Tuberculosis (TB) is well known as a major infectious disease and one of the top 10 causes death worldwide. TB can affect anyone, everywhere but it has predilection for those with diabetes, human immunodeficiency virus (HIV), smoking undernutrition. Myanmar, 54 million people, an incidence all forms 322 per 100 000 population, mortality 36 population. Myanmar 30 high burden countries because emerging challenge drug-resistant HIV-associated TB, on prevalence drug-susceptible TB.1 In clinicians, epidemiologists administrators are collaboratively involved to tackle this prevalent disease. The natural course presentations tuberculous infection in do not go against what we have learnt. Primary mostly irrelevant seldom recognized clinically. adults, pulmonary most common form—post-primary TB. proportion was found be 45.3–56.7% according Medical Registry (2015–2019) Mandalay General Hospital, leading tertiary hospitals.2 typical presentation gradual onset cough constitutional symptoms chest x-ray (CXR) finding parenchymal lesions unremarkable However, some specific such endobronchial intrathoracic lymphadenopathy pleural diagnosis becomes tricky. Treatment usually straightforward standardized treatment setting primary care. It sometimes needs tailored from regimen either modified chronic liver renal diseases, or changed individualized if there drug side effects. Furthermore, many respiratory complications even after active successfully treated, especially extensive Post bronchiectasis, fibrosis pleura lung parenchyma, bronchial stricture stenosis, recurrent haemoptysis new development obstructive airway clinical encounters our daily practice. these settings, comprehensive knowledge pulmonology, skill expertise investigational tools essential successful management. entity bronchoscopy followed by biopsy bronchoalveolar lavage/bronchial washing standard diagnostic procedures. form involving mediastinal lymph nodes, advanced bronchoscopic procedure ultrasound-guided transbronchial needle aspiration core often used. Pleural extrapulmonary hospital With regard diagnosis, thoracocentesis usual Routinely, taken closed ultrasound assistance. when undiagnosed exudative effusion, medical thoracoscopic choice requires video-assisted biopsy. confirmed histopathological granulomatous Another auxiliary method determination adenosine deaminase, enzyme liberated activated lymphocytes.3 Laboratory aspects practice expanded sputum smear microscopy molecular technologies. Historically, acid-fast bacilli frontline tool. Molecular tests, Xpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) testing detect DNA Mycobacterium tuberculosis mutations associated resistance, rapid rule out rifampicin resistance. Isolating bacteria solid culture, Lowenstein–Jensen media liquid Growth Indicator Tube system-960 (Becton, Dickinson Company, UK) susceptibility first- second-line anti-tuberculous drugs using line probe assay important tests (DR-TB) management.4 QuantiFERON-TB Gold (Qiagen, Dusseldorf, Germany) test commercially available interferon-gamma release alternative tuberculin skin latent infection. Among imaging investigations, CXR tool both hospitals care useful only presumptive also valuable identifying other diseases people need follow-up. recent years, achieved remarkable milestones management control stated World Health Organization (WHO) Global Report (2020)5 sixth Joint Monitoring Mission (2019) report. dedications tuberculogists, providers public private sectors greatly appreciated achievements. National Program (NTP) provides basic services, registration through health network (Fig. 1). program adopted WHO-recommended DOTS strategy, later transformed Stop strategy recently End strategy.1 Standardized constitutes 6 months first-line (2 isoniazid (H) + (R) pyrazinamide (Z) ethambutol (E), 4 HR). Previously treated patients undergo prior retreatment 8-month (3 HRZE/5 HRE) given without success rate up 87% registered patients.6 DR-TB another challenging problem. estimated multidrug-resistant 5.1% cases 27% previously cases. conventional 20-month long, injection-containing implemented programme more than 75%. extensively (XDR-TB), regimens based results includes (bedaquiline delamanid).4 Very recently, started transition plan fully oral DR-TB. TB/HIV collaborative activities established nationwide. impact coronavirus 2019 (COVID-19) pandemic, inevitable setbacks together non-COVID diseases. Hence, timely response been settings so delay effective during pandemic. NTP makes its way forward accelerate strengthen programmes. This road map strength everyone around region strive towards achieving targets global difficult times.